A Prospective Study of Duodenal Bulb Biopsy in Newly Diagnosed and Established Adult Celiac Disease

Evans, K E; Aziz, Imran; Cross, Simon S.; Sahota, G R; Hopper, Andrew D; Hadjivassiliou, Marios; Sanders, David S.

doi:10.1038/ajg.2011.171

Cited by 101 publications

(75 citation statements)

References 39 publications

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“…[8][9][10][11][12] However the practice of D1 biopsy has not been universally accepted. Indeed, in a recent audit of non-specialist hospitals in the UK, a D1 biopsy was performed in only 18/914 (2.0%) of patients undergoing duodenal biopsy to diagnose celiac disease and only in 10% of patients in a recent US study.…”

Section: Discussionmentioning

confidence: 99%

“…Consecutive patients attending a single research endoscopy list, where routine duodenal biopsy is employed, were recruited in a significant expansion of our previous study of 376 patients. 12 Patients attending include those with suspected celiac disease but also include general and open access referrals for all upper GI symptoms. All recruited patients received quadrantic biopsies from the second part of the duodenum.…”

Section: Methodsmentioning

confidence: 99%

“…9 Prospective data from a heterogeneous group of small studies has suggested that interpretation of D1 biopsies is possible and may be the only site of villous atrophy in newly diagnosed celiac disease, (ultra-short celiac disease, (USCD)) ( Table 1). [8][9][10][11][12][13] D1 biopsy however is not yet fully accepted for several reasons. Firstly, the majority of these studies are based on small cohorts with inadequate control groups used.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and Immunologic Features of Ultra-Short Celiac Disease

et al. 2016

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Section: Discussionmentioning

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Section: Methodsmentioning

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Section: Introductionmentioning

confidence: 99%

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Clinical and Immunologic Features of Ultra-Short Celiac Disease

et al. 2016

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“…Cases have been reported in which villous atrophy and intraepithelial lymphocytosis, characteristic of celiac disease, were identified in biopsy specimens of the mucous membrane of the terminal part of the ileum, taken during ileocolonoscopy [4]. Every tenth celiac disease patient has isolated lesions in the duodenal bulb [5,6]. A few patients have microscopic and macroscopic lesions in further parts of the small intestine without any abnormalities in the duodenum, which makes it impossible to confirm celiac disease based on biopsy specimens taken from mucous membranes during a traditional gastroduodenoscopy [3].…”

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The Range of Lesions in the Small Intestine of Children with Celiac Disease Determined by Capsule Endoscopy

2014

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Background. Celiac disease is a chronic gluten intolerance which can cause small intestinal inflammatory lesions of different intensity, scope and distribution. Objectives. The aim of the study was to assess the distribution and scope of lesions revealed by endoscopy in the small intestine of children and adolescents with untreated celiac disease. Material and Methods. A total of nine patients aged from 15 to 18 years (average age: 16 years) were enrolled in the study, including seven girls and two boys who had been diagnosed with histologically confirmed celiac disease. Following a bowel cleansing all the patients were subjected to examination of the small intestine using an endoscopic capsule (EndoCapsule EC, Olympus, Tokyo, Japan). Results. The examination was complete in eight of the patients. In six patients the capsule endoscopy revealed continuous lesions in the duodenum and the proximal small intestine. In one child continuous lesions occurred only in a short section of the bowel, within the duodenum. In one patient the abnormalities were located in the proximal small intestine without any lesions in duodenum. In one case, segmental lesions were observed in the distal small intestine, without any lesions in the duodenum or in the proximal part of the bowel. The results for the endoscopic markers of celiac disease were as follows: in all the patients a significant shortening or complete lack of villous structure was noted; in six patients scalloping was observed at the peaks of the circular folds; in three patients granulation was observed; and in three patients a mosaic mucosal pattern was noted. Conclusions. The most frequent type of lesions revealed by capsule endoscopy in pediatric patients with untreated celiac disease seems to be continuous lesions in the duodenum and the proximal small intestine. Some patients can develop macroscopic lesions (and probably microscopic ones as well) that are beyond the reach of traditional endoscopy. In such cases, capsule endoscopy can help to determine and diagnose celiac disease and to establish the need for lifelong dietary treatment (Adv Clin Exp Med 2014, 23, 5, 785-790).

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“…3 Duodenal bulb is the first contact point of gluten and in 9-13% of patients may be the only location of villous atrophy. 3,14,15 However, inflammatory changes of peptic injury and distortion of villi in areas overlying Brunner glands or lymphoid follicles may cause certain difficulties in interpretation of duodenal bulb specimens.…”

Section: An Approach To Biopsymentioning

confidence: 99%

Diagnostic challenges in celiac disease

et al. 2017

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Diagnosis of celiac disease in adults is currently based on serologic tests in combination with histopathological assessment of small intestinal biopsy specimens. High titers of celiac-specific antibodies in immunocompetent patients with villous atrophy in a good quality biopsy sample allow us to state a confident diagnosis. The relief of symptoms and histological improvement after embarking on a gluten free diet further support the initial diagnosis. However, in some cases, these conditions are not fulfilled, which requires a critical evaluation of laboratory and histopathology results and a consideration of other potential causes for the observed pathologies. To avoid diagnostic uncertainty, both biopsy and laboratory testing should be performed on a diet containing gluten. Immune deficiency, cross reaction of antibodies and possibilities of seronegative or latent celiac disease should be considered while evaluating serology results. Uneven distribution and variable intensity of histopathological changes in the small intestine along with multiple disorders presenting a similar specimen image may lead to invalid biopsy results. Additional laboratory testing and careful examination of a patient's history may deliver important data for a differential diagnosis and a more specific biopsy evaluation. Persistence or recurrence of symptoms, despite the ongoing treatment, requires a revision of the initial diagnosis, an evaluation of the gluten free diet and a search for concurrent disorders or complications.

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A Prospective Study of Duodenal Bulb Biopsy in Newly Diagnosed and Established Adult Celiac Disease

Abstract: VA may be present only in the duodenal bulb. This study suggests that the optimal assessment of patients in whom celiac disease is suspected (with positive serology) and those with established celiac disease requires a duodenal bulb biopsy in addition to distal duodenal biopsies.

Cited by 101 publications

References 39 publications

Clinical and Immunologic Features of Ultra-Short Celiac Disease

Clinical and Immunologic Features of Ultra-Short Celiac Disease

The Range of Lesions in the Small Intestine of Children with Celiac Disease Determined by Capsule Endoscopy

Diagnostic challenges in celiac disease

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